General Hospital Laboratory Research Articles

Association between vitamin D deficiency and lipid and non-lipid markers of cardiovascular diseases in the middle east region.

Previous studies have associated vitamin D deficiency with cardiovascular disease (CVD) markers. The underlying mechanism remains elusive. Lipid and non-lipid markers of CVD and their relationship to vitamin D deficiency have not been assessed simultaneously. To measure the association between vitamin D deficiency and non-lipid markers of CVD after adjustment of lipid markers. This cross-sectional study used the following biological data, which was routinely collected in a general hospital laboratory database between 2011 and 2016: 25OH vitamin D [25(OH)D], creatinine, CKD-EPI eGFR (eGFR), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), uric acid, γ-glutamyl transferase (γGT), C-reactive protein (CRP), total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and a surrogate for CVD. Crude odds ratios (ORs) and ORs adjusted for lipid profile, gender and age using separate logistic regression models were derived. A total of 8658 subjects were included. Half had 25(OH)D < 20 ng/mL. 25(OH)D was associated with increased odds of CRP, eGFR, increased uric acid, γGT, FPG, HbA1c, male gender, CV status, and abnormal lipid markers. After adjustment for lipid markers, age, and gender, vitamin D deficiency was associated with increased odds of CRP, eGFR, γGT, FPG, HbA1c, and the surrogate for CVD. In this exploratory analysis, the first of its kind in the MENA region, vitamin D deficiency was associated with abnormal lipid markers, non-lipid markers of CVD, male gender, lower eGFR, and a surrogate variable for CVD. The association between vitamin D deficiency and non-lipid markers of CVD persisted after adjustment for lipid markers, age, and gender.

Validation of the Friedewald formula for the estimation of low density lipoprotein cholesterol in a sub-Saharan African population

Introduction : low density lipoprotein cholesterol (LDL-C) levels are used to estimate cardiovascular disease (CVD) risk and to guide prescriptions. To circumvent the challenges of direct LDL-C measurement, guidelines recommend the use of Friedewald formula derived LDL-C levels. Despite reported limitations of this formula, its validity in sub-Saharan Africans has not been adequately investigated. The objective was to assess the validity of the Friedewald formula derived against directly measured LDL-C in adult Cameroonians. Methods : we reviewed the fasting lipid profiles of 2500 patients, performed between March 2012 and January 2016 using enzymatic colorimetric method (reference), at the Douala General Hospital laboratory. The Friedewald formula was used to calculate LDL-C from total cholesterol, high density lipoprotein cholesterol and triglyceride levels. Calculated LDL-C values were compared to the reference values and clinical significance of differences between the two methods was assessed using total error allowable (TEa). Results : the difference between means of Friedewald-calculated and the reference LDL-C values was neither statistically nor clinically significant (3.33±1.51 vs. 3.33 ± 1.25 mmol/l; p = 0.704). The calculated LDL-C correlated positively with the measured LDL-C value (r = 0.749) and both methods showed a good agreement on Bland-Altman plot. Conversely, there was only moderate agreement (kappa=0.478, 95% CI: 0.455-0.502) between the two values in the stratification of cardiovascular risk according to the National Cholesterol Education Programme/Adult Treatment Panel III. Consequently, 40.6% of the participants were misclassified. Conclusion : Friedewald formula is technically accurate but has a modest clinical accuracy which can translate into a substantial misclassification of patients’ cardiovascular risk and subsequent inappropriate therapeutic decisions.

Validation of the Friedewald formula for the estimation of low density lipoprotein cholesterol in a sub-Saharan African population

BackgroundLow density lipoprotein cholesterol (LDL-C) levels are used to estimate cardiovascular disease (CVD) risk and to guide prescriptions. To circumvent the challenges of direct LDL-C measurement, guidelines recommend the use of Friedewald formula derived LDL-C levels. Despite reported limitations of this formula, its validity in sub-Saharan Africans has not been adequately investigated. ObjectiveTo assess the validity of the Friedewald formula derived against directly (homogeneous) measured LDL-C in adult Cameroonians. MethodsWe reviewed the fasting lipid profiles of 2500 patients, performed between March 2012 and January 2016 using enzymatic colorimetric method (reference), at the Douala General Hospital laboratory. The Friedewald formula was used to calculate LDL-C from total cholesterol, high density lipoprotein cholesterol and triglyceride levels. Calculated LDL-C values were compared to the reference values, and clinical significance of differences between the two methods was assessed using total error allowable (TEa). ResultsThe difference between means of calculated and the reference LDL-C values was neither statistically nor clinically significant (3.33±1.51 vs. 3.33±1.25mmol/l; p=0.704). The calculated LDL-C correlated positively with the measured LDL-C value (r=0.749) and both methods showed a good agreement on Bland-Altman plot. Conversely, there was only moderate agreement (kappa=0.478, 95% CI: 0.455–0.502) between the two values in the stratification of cardiovascular risk according to the National Cholesterol Education Program/Adult Treatment Panel III. Consequently, 40.6% of the participants were misclassified. ConclusionFriedewald formula is technically accurate but has a modest clinical accuracy which can translate into a substantial misclassification of patients' cardiovascular risk and subsequent inappropriate therapeutic decisions.

Twenty-first century cancer patterns in small island nations: Grenada and the English-speaking Caribbean.

Grenada is a small island nation of 105,000 in the Caribbean with one single general hospital and pathology laboratory. This study assesses cancer incidence on the island based on existing pathology reports, and compares the cancer mortality burden between Grenada and other Caribbean nations. Age-adjusted overall and site-specific cancer "incidence" rates (based on pathology reports) and mortality rates were calculated and compared for 2000-2009. Next, mortality rates for a more recent period, 2007-2013, were calculated for Grenada and a pool of English-speaking, majority African-ancestry Caribbean island nations. Lastly, for direct mortality comparisons by cancer site, mortality rate ratios were computed using negative binomial regression modeling. The pathology reports alone do not suffice to calculate national incidence rates but cancer mortality rates are rapidly increasing in Grenada. The leading causes of cancer mortality were prostate and lung cancers among men, and breast and cervical cancers among women. Overall cancer mortality is significantly higher for both male and female Grenadians than their Caribbean counterparts: RR 1.43 (95% CI 1.32-1.55) and RR 1.26 (95% CI 1.15-1.38), respectively. High prostate and non-Hodgkin's lymphoma rates are concerning. Given the small existing cancer infrastructure, excessive mortality in Grenada compared to its neighbors may be disproportionately more attributable to low survival than a high cancer risk. Global solutions will be required to meet the cancer control needs of geographically isolated small nations such as Grenada.

Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.

Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. Prospective, crossover, nonrandomized interventional study. Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil). Critically ill obese patients with acute respiratory failure and anesthetized swine. Clinical data from 16 mechanically ventilated critically ill obese patients were analyzed. An animal model of obesity with reversible atelectasis was developed by placing fluid filled bags on the abdomen to describe changes of lung mechanics, lung morphology, and pulmonary hemodynamics in 10 swine. In obese patients (body mass index, 48 ± 11 kg/m), 21.7 ± 3.7 cm H2O of positive end-expiratory pressure resulted in the lowest elastance of the respiratory system (18.6 ± 6.1 cm H2O/L) after a recruitment maneuver and decremental positive end-expiratory pressure and corresponded to a positive (2.1 ± 2.2 cm H2O) end-expiratory transpulmonary pressure. Ventilation at lowest elastance positive end-expiratory pressure preceded by a recruitment maneuver restored end-expiratory lung volume (30.4 ± 9.1 mL/kg ideal body weight) and oxygenation (273.4 ± 72.1 mm Hg). In the swine model, lung collapse and intratidal recruitment/derecruitment occurred when the positive end-expiratory transpulmonary pressure decreased below 2-4 cm H2O. After the development of atelectasis, a decremental positive end-expiratory pressure trial preceded by lung recruitment identified the positive end-expiratory pressure level (17.4 ± 2.1 cm H2O) needed to restore poorly and nonaerated lung tissue, reestablishing lung elastance and oxygenation while avoiding increased pulmonary vascular resistance. In obesity, low-to-negative values of transpulmonary pressure predict lung collapse and intratidal recruitment/derecruitment. A decremental positive end-expiratory pressure trial preceded by a recruitment maneuver reverses atelectasis, improves lung mechanics, distribution of ventilation and oxygenation, and does not increase pulmonary vascular resistance.

Urinary Kidney Injury Molecule-1 (KIM-1) in Early Diagnosis of Acute Kidney Injury in Pediatric Critically Ill

Acute kidney injury (AKI) often associated with a high hospital morbi-mortality rate in the intensive care unit patients. Kidney injury molecule-1 (KIM-1), has many characteristics of ideal biomarker for kidney injury. The aim of this study was to compared the temporal pattern of elevation urinary KIM-1 level following critically ill children with SCr as standart biomarker of AKI. Prospective analytic observational study was conducted during October to March 2014 in the Saiful Anwar General Hospital and Physiology Laboratory Brawijaya University. There were 13 critically ill as subjects. SCr and KIM-1 levels from all subjects were measured three times ( at admission, after 1 st and 6 th hour). Subjects were devided into AKI - non-AKI groups by SCr level and survivor - non survivor group at the and of the observations. Results showed that there were significantly increased levels of KIM-1 in the AKI and non-AKI and survivor-non survivor group at time point. However, we found that delta KIM-1 at time point increased significant in non AKI group and survivor group. KIM-1 at admission can diagnosed AKI in critically ill children. We conclude that urinary KIM-1 is a sensitive non-invasive biomarker to diagnosed acute kidney injury in critically ill children. Increase level of KIM-1 by time shows protective and good outcome in critically ill children.

Trends and changes in Clostridium difficile diagnostic policies and their impact on the proportion of positive samples: a national survey

In June 2012, Israeli guidelines for laboratories were published defining the recommended methods for diagnosis of Clostridium difficile infection (CDI). We conducted this survey to examine the effects of the new recommendations on the proportions of rejected and positive samples by the different methods. A survey was mailed to the directors of all general hospital (GH) and health maintenance organization (HMO) clinical microbiology laboratories. The report was divided into two periods, before and after implementation of the guidelines. Surveys were completed by 13/28 GH laboratories and 5/6 HMO laboratories. All 18 of these laboratories used C. difficile toxin (CDT) enzyme immunoassay alone during the first period of the survey. In the second period, nine laboratories (Group A) used CDT-PCR: two of them used this method exclusively while the other seven used it to resolve most (>90%) of the discrepant results (glutamate dehydrogenase antigen (GDH) +/CDT−]. The other nine laboratories (Group B) used combined GDH/CDT assay, using CDT PCR in only a minority (< 20%) of GDH+/CDT− cases. The overall proportion of rejected samples increased from 9.5% in the first period to 13.9% in the second (p <0.001). Between the first and second periods the proportion of positive samples increased from 9.0% to 11.6% in group A laboratories (p <0.001), but decreased from 12.9% to 9.7% in group B laboratories (p <0.001). Implementation of the guidelines has resulted in a significant increase in the proportion of rejected samples and in the proportion testing positive, suggesting more appropriate test utilization and improved sensitivity in the laboratory diagnosis of CDI.

CRP Marker Adds a Risk Factor for Lebanese Obese Children and Adolescents

Abstract INTRODUCTION: Obesity in children and adolescents is increasingly recognized as a major health concern. It is actually a pandemic disease by itself. Several cytokines and inflammatory mediators are induced in obesity and they may trigger atherosclerosis, coronary disease and heart failure. It is reported that increased high sensitivity CRP was an independent predictor of cardiovascular events in adults and this relation is less clear in pediatrics age group. OBJECTIVES: 1) To Measure the high sensitivity C - Reactive Protein (CRP) level in children and adolescents who are obese or normal weight (control group) with no known history of associated co morbidities and define the abnormality in CRP level among obese children and adolescent in Lebanese population. 2) To prove that the increase in CRP among obese children could be as early as 2 years of age. 3) Follow up the obese children and adolescents who had positive CRP with scheduled diet regimen by help of the nutritionist and seek the effect of diet on CRP level. METHOD: This is a prospective case control study, collecting children and adolescents between 2 and 15 years of age and determining the obese group according to definition of obesity which refers to BMI that vary with age and sex. Obese group selected if BMI > 95th percentile and normal weight (control group) selected if BMI < 85th percentile for age and sex respectively. This was achieved by using document analysis, paper based questionnaire, interviews, complete physical examination, direct measurement of weight and height. Then after justification for the inclusion criteria, CRP level done at Makassed General Hospital laboratory. RESULTS: CRP level was significantly different between obese and control group (normal weight). All subjects of control group had negative CRP value with mean result of 0.08, while 33 subjects (57.9%) of obese group had positive CRP value with a mean of 0.83 that has statistically significant P value of 0.003. This relation was observed among obese children as young as 2 years of age. For All members who had weight reduction the CRP decreased, while only one subject who lost the dietary control had elevation in CRP level. CONCLUSIONS: We conclude that obesity in children and adolescents with no comorbidities is strongly associated with elevated CRP level (a high sensitivity inflammatory marker) which may reflect a future increase in the risk of developing atherosclerosis process. This relation was observed among obese children as young as 2 years of age. Changing life style according to diet regimen lowered CRP level in direct correlation to the weight reduction.

Definition of Reference Limits for Autoantibodies to Thyroid Peroxidase and Thyroglobulin in a Large Population of Outpatients Using an Indirect Method Based on Current Data

The reference limits for thyroid antibodies are generally made by measuring thyroid peroxidase and thyroglobulin antibody values in a group of healthy subjects (direct method), as proposed by the National Academy of Clinical Biochemistry. To define the upper reference limits of thyroid peroxidase and thyroglobulin, by using an indirect method to analyze data from a large number of outpatients that were stored in the information system of a general hospital laboratory. Thyroid peroxidase and thyroglobulin values from 21 492 patients, who had undergone antithyroid antibody measurements, were retrieved from the laboratory information system; the upper reference limits (in the top 97.5 percentile) were calculated using the indirect Kairisto method, after exclusion of outliers. The mean upper reference limits for females and males were 15 kIU/L and 9 kIU/L for thyroid peroxidase, and 21 kIU/L and 19 kIU/L for thyroglobulin, respectively. The upper limits showed minimal or no differences in the different age classes in either females or males. Using a vast population of patients, we demonstrated that the upper limits for thyroid antibodies are much lower than the values obtained with classic, direct methods and that they do not vary in relation to age and sex.

Clostridium Difficile associated diarrhoea (CDAD): An audit of mandatory testing in a district general hospital laboratory

Clostridium Difficile associated diarrhoea (CDAD): An audit of mandatory testing in a district general hospital laboratory

Advances in Development of Dopaminergic Aporphinoids

ADVERTISEMENT RETURN TO ISSUEPerspectiveNEXTAdvances in Development of Dopaminergic AporphinoidsAo Zhang, Yi Zhang, Alan R. Branfman, Ross J. Baldessarini, and John L. NeumeyerView Author Information Synthetic Organic & Medicinal Chemistry Laboratory, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China, The Branfman Family Foundation, 418 Queen Anne Road, Cherry Hill, New Jersey 08003, Department of Psychiatry & Neuroscience Program, Harvard Medical School, Boston, Massachusetts 02114, Neuropharmacology Laboratory Mailman Research Center, McLean Division of Massachusetts General Hospital, Belmont, Massachusetts 02478-9106, and Medicinal Chemistry Laboratory, Alcohol & Drug Abuse Research Center, McLean Division of Massachusetts General Hospital, Belmont, Massachusetts 02478-9106. Cite this: J. Med. Chem. 2007, 50, 2, 171–181Publication Date (Web):December 16, 2006Publication History Received8 August 2006Published online16 December 2006Published inissue 1 January 2007https://doi.org/10.1021/jm060959iCopyright © 2007 American Chemical SocietyRIGHTS & PERMISSIONSArticle Views1448Altmetric-Citations90LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InReddit Read OnlinePDF (213 KB) Get e-AlertsSUBJECTS:Agonists,Antagonists,Receptors,Rodent models,Selectivity Get e-Alerts

Rapid review in cervical cytology: a retrospective review of cases detected on rapid review within a DGH cytology department and subsequent outcome.

We retrospectively reviewed smears detected by rapid review within a district general hospital (DGH) laboratory over a period of 33 months and the subsequent histological or cytological outcome. Sixty-three cases had adequate follow-up data: 32 subsequently had two negative smears and 31 had a histological abnormality on subsequent biopsy. Twenty were high-grade lesions (CIN2, CIN3 or a glandular lesion) and eight of these were preceded by a low-grade smear abnormality. We reviewed and compared the pattern and distribution of smear abnormalities in these 63 cases. Abnormalities were often present within few cells (76%, n = 48 with 50 abnormal cells or less) or in micro-biopsies (27%, n = 17). There was no statistical difference in the pattern and distribution of smear abnormality between the rapid review-detected smears with a biopsy-proven abnormality and those with negative follow-up smears. Overall, the positive predictive value for high-grade CIN detected by rapid review (75%) was within NHSCSP achievable standards targets. This review of rapid review-detected abnormalities and the biopsy and cytological follow-up reiterates the importance of the method in cervical screening.

Fine Needle Aspiration Biopsy of Vertebral Lesions

To evaluate the accuracy of fine needle aspiration biopsy (FNAB) in the diagnosis of vertebral lesions. Eighty-nine FNAB cases of vertebral lesions from January 1996 to December 2001 were retrieved from the Allegheny General Hospital laboratory information system. The cases were reviewed and correlated with clinical findings, including previous clinical history, primary site of malignancy and final pathologic diagnosis. ENAB diagnoses were malignant in 43 cases, benign in 35, suspicious in 1, unsatisfactory in 7 and false negative in 3. Previous clinical history included malignancy (37 patients), osteomyelitis and systemic disease (11), and nonspecific or no history (41). In 34 cases (38.2%) both aspirates and core biopsies were available, and the diagnoses correlated in 29/34 cases (85%). Surgical or core biopsies in the unsatisfactory/suspicious group showed malignancy in 4 cases (50%). The sensitivity of FNAB of vertebral lesions was 96%, specificity 100%, positive predictive value 100% and negative predictive value 92%, with no false positive cases. FNAB of vertebral lesions is an effective, sensitive and specific procedure in the diagnostic workup of a patient with or without a prior history of malignancy. Surgical pathology examination, including core biopsies of unsatisfactory or suspicious lesions, can further improve the diagnostic yield.

Change from dual- to single-platform reporting of CD4/CD8 values: experience from a small district general hospital laboratory

Accurate and reliable CD4 and CD8 counts are essential for monitoring HIV disease progression or successful therapy. CD4 and CD8 counts can be determined on a flow cytometer by either single- or dual-platform technology. Dual-platform technology uses a haematology analyser to obtain a total white cell count and lymphocyte absolute count. CD4 and CD8 absolute values are then calculated from the CD4 and CD8 percentage positive results obtained from the flow cytometer. Single-platform technology uses latex beads of a predefined concentration, which are added to the blood sample immediately before flow cytometric analysis, thereby removing the need to use an additional analyser. Recent recommendations propose that single-platform technology should be the gold standard for CD4 measurement because it offers better inter-laboratory coefficients of variation (CVs). Before changing to single-platform technology in our department, CD4 and CD8 absolute counts, determined on 20 healthy volunteers, were used to establish new normal ranges for single-platform technology (Coulter epics XL), permitting absolute value data for dual-platform and single-platform technologies to be compared. Data obtained with single-platform technology was significantly higher for both CD4 and CD8 (P=0.001 and P=0.003, respectively). For CD4, mean single-platform value was 0.993 x 109/L (+SD = 0.510 – 1.376) and dual-platform value was 0.920 x 109/L (+SD = 0.500 – 1.340). For CD8, single-platform value was 0.483 x 109/L, (+SD = 0.207 – 0.756) and dual-platform value was 0.457 x 109/L (+SD = 0.222 – 0.692). Thus, the differences between dual- and single-platform absolute CD4 and CD8 results were small (8% and 6%, respectively) but significant. It is important, therefore, that clinicians closely monitoring CD4 and CD8 values and are informed of any laboratory changes.

3-D-Conformal Radiation Therapy for Pediatric Giant Cell Tumors of the Skull Base

Giant cell tumors (GCT) of the base of skull are rare neoplasms. This report reviews the treatment of four pediatric patients presenting with aggressive giant cell tumor, using fractionated and combined, conformal proton and photon radiation therapy at Massachusetts General Hospital and Harvard Cyclotron Laboratory. Three female patients and one adolescent male, ages 10-15 years, had undergone prior, extensive surgical resection(s) and were treated for either primary (two patients) or recurrent (two patients) disease. Gross residual tumor was evident in three patients and microscopic disease suspected in one patient. Combined proton and photon radiation therapy was based on three-dimensional (3-D) planning, consisting of fractionated treatment, one fraction per day at 1.8 CGE (cobalt-gray equivalent) to total target doses of 57.6, 57.6, 59.4, and 61.2 Gy/CGE. With observation times of 3.1 years, 3.3, 5.3, and 5.8 years, all four patients were alive and well and remained locally controlled without evidence of recurrent disease. Except for one patient with partial pituitary insufficiency following radiotherapy for sellar recurrent disease, thus far no late effects attributable to radiation therapy have been observed. 3-D-conformal radiation therapy offers a realistic chance of tumor control for aggressive giant cell tumor in the skull base, either postoperatively or at time of recurrence. Conformal treatment techniques allow the safe delivery of relatively high radiation doses in the pediatric patient without apparent increase of side effects.

How to detect current toxoplasma infection

This study seeks to identify the best way to detect current toxoplasma infection for district general hospital laboratories. One hundred ‘ordinary’ and 174 ‘difficult’ sera are categorised into either an ‘evidence’ or ‘no evidence’ group for current toxoplasma infection. Twelve test protocols are investigated using different combinations of one whole antibody latex test (Eiken Toxoreagent), one in-house specific IgG enzyme-linked immunosorbent assay (ELISA) and three specific IgM assays (Toxo-ISAGA, in-house BAM ELISA IgM and Toxonostika ELISA M). The Eiken latex and in-house IgG assays produced significantly fewer false-negative results than were obtained with the single IgM test or the IgG and IgM test protocols (P<0.05), but a greater number of false-positive results (102/274 and 115/274, respectively). Of the IgM assay test protocols, the three IgM assays in combination produced the least number of false-negative results (1/274). However, a significantly greater number of false-positive results were produced than with one or two IgM tests or an IgG and any IgM test in combination (P<0.001). We recommend testing with three IgM tests, or a whole antibody (Eiken) or IgG-specific assay, and that positive or clinically important negative samples be referred to a reference laboratory for confirmation.

Cell-culture system for continuous production of Toxoplasma gondii tachyzoites.

The aim of this study was to identify a sustainable cell line and culture method that could continuously provide a sufficient quantity of Toxoplasma gondii tachyzoites to serve the needs of a general hospital laboratory. Three continuous cell lines (HeLa, LLC and Vero) and three cell-culture methods (culture in conventional flasks, culture in membrane-based flasks and an automated culture system) were investigated. In multiplicity-of-infection and time-course experiments, HeLa was the cell line of choice. Harvests from HeLa cells had significantly higher tachyzoite yields than those from LLC cells (P<0.00005) or Vero cells (P<0.05). Membrane-based flasks gave higher yields (6.15x10(6) tachyzoites/ml) than conventional flasks (1-2x10(6) tachyzoites/ml) initially, but these were not sustained. The automated cell-culture system was unsuitable for parasite culture. Continuous passage in 25 cm2 flasks was successful, yielding 1x10(6) tachyzoites/ml; viability exceeded 90% after 96-120 h of infection throughout 38 passes, during which time the viability improved and the time to harvest became more consistent. Toxoplasma gondii grown in continuous culture in HeLa cells can provide a regular supply of viable tachyzoites. Demonstration that HeLa-derived tachyzoites could be used for the dye test confirms the potential of this in vitro system for use in general hospital laboratories.

Laboratory Accreditation The Next Generation of Quality Improvement in Thailand

A Thailand quality assessment program called iThe External Quality Assessment in Clinical Chemistry, EQAC” was found in 1986. A blind lyophilized control serum is monthly-cycle distributed to the participants and the returned test-report values are evaluated by a computed program. Evaluated report Mean Variance Index Scores (MVIS) and mean score of all tests are posted back to the participants.In 1999 the program was applied by 324 laboratory participants of which 59% of general hospital and community health hospital laboratory, 29% of private hospital laboratory including polyclinics, and 12% of the others. By now as many as 144 trials of 23 biochemistry tests at different methods were assessed from the EQAC program. Participant communication, knowledge update and enhanced quality encouragement have been managed by mean of participants' VIS from 120 to 93 during 1987–1998.For the next millennium, the implementation of ISO/IEC Guide 25 for quality system in clinical laboratory will be a promising strategy...

Laboratory Accreditation the Next Generation of Quality Improvement in Thailand

A Thailand quality assessment program called ìThe External Quality Assessment in Clinical Chemistry, EQAC” was found in 1986. A blind lyophilized control serum is monthly-cycle distributed to the participants and the returned test-report values are evaluated by a computed program. Evaluated report Mean Variance Index Scores (MVIS) and mean score of all tests are posted back to the participants. In 1999 the program was applied by 324 laboratory participants of which 59% of general hospital and community health hospital laboratory, 29% of private hospital laboratory including polyclinics, and 12% of the others. By now as many as 144 trials of 23 biochemistry tests at different methods were assessed from the EQAC program. Participant communication, knowledge update and enhanced quality encouragement have been managed by mean of participants' VIS from 120 to 93 during 1987–1998. For the next millennium, the implementation of ISO/IEC Guide 25 for quality system in clinical laboratory will be a promising strategy of quality improvement in Thailand. The Ministry of Public Health is step forward to adopt this guide for certifying standard laboratories. These efforts will be a first step towards the next generation of quality improvement for clinical laboratory in Thailand.

Temporal Lobe (TL) Damage Following Surgery and High-Dose Photon and Proton Irradiation in 96 Patients Affected by Chordomas and Chondrosarcomas of the Base of the Skull

Purpose: To determine the temporal lobe (TL) damage rate in 96 patients treated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull. Methods and Materials: The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as “primary tumors” and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group #85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose–volume histograms were obtained for these patients. Results: Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from the tumor bed. Symptoms were severe to moderate in 8 patients. Several baseline factors, tumor- or host-related, were analyzed to evaluate their predictivity for TL damage: age, gender, tumor site, histology, type of presentation, type and number of surgical procedures, primary tumor volume, prescribed dose, normal tissue involvement, and volume of TL receiving doses ranging between 10 and 50 CGE or more. Only gender, in a univariate analysis (log rank) was a significant predictor of damage (0.0155), with male patients being at significantly higher risk of TL injury. In a stepwise Cox regression that included gender as a variable, no other baseline variable improved the prediction of damage. Conclusions: The 2- and 5-year cumulative TL damage rates were 7.6 and 13.2%, respectively. Despite the different TL damage rates related to age, tumor volume, number of surgical procedures prior to radiation therapy, and prescribed doses to the tumor, only gender was a significant predictor of damage ( p = 0.0155) using a univariate (log rank) test. Chordomas and chondrosarcomas of the base of the skull may represent an interesting model to evaluate the TL damage rates because of their extradural origin, displacing the white matter instead of infiltrating it as gliomas do, because of their longer local recurrence-free survival other than gliomas and other brain tumors and because of the high doses of irradiation delivered to the target volume to obtain local control.